An innovative interprofessional education simulation for athletic training and prelicensure nursing students: Development, implementation, and student perspectives

Abstract Background The purpose of this article is to describe the development, implementation, and evaluation of a Simulation Interprofessional Education (Sim‐IPE) activity for healthcare students from different disciplines (athletic training [AT] and nursing). The objective for the Sim‐IPE activity was to engage AT and prelicensure nursing students in a realistic healthcare scenario to enhance knowledge about one another's profession, develop interprofessional skills, collaborate with one another, and communicate effectively as a team as they performed care. Methods This mixed methods study employed a one‐time posttest design for a convenience sample of AT and prelicensure nursing students following a simulation intervention. Students completed the Student Perceptions of Interprofessional Clinical Education‐Revised (SPICE‐R) survey and answered open‐ended response questions. Results Thirteen students (N = 13) from Cohort 1 and 12 students (N = 12) from Cohort 2 completed the SPICE‐R survey. Most students strongly agreed/agreed for each of the SPICE‐R survey questions. Qualitative findings indicated the students positively perceived the Sim‐IPE activity as it helped them discover the value of interprofessional patient care. Discussion The quantitative findings indicated that the students found the Sim‐IPE an effective learning methodology to achieve the objectives while the qualitative findings gave further insight into the students' perceptions of interprofessional teamwork and the value of the prebrief session conducted before the simulation. The findings will inform future Sim‐IPE activities involving additional groups of healthcare students.


| BACKGROUND
Interprofessional education (IPE) and collaboration have been established as essential components in healthcare education programs needed to prepare students for their future roles. 1,2 Engaging students in IPE can increase knowledge, foster competency, and strengthen skills for interacting with other healthcare workers. 3,4 Research shows effective interprofessional collaboration improves healthcare quality and patient safety and reduces healthcare costs. [5][6][7] Simulation is a well-studied, evidence-based approach used to educate healthcare students. [8][9][10] Simulation IPE (Sim-IPE) is an experiential learning methodology that promotes student interaction, collaboration with other professions, team-based decision-making, and thus, enhances students learning from and with each other. 11,12 Sim-IPE fosters the assimilation of new knowledge, skills, and attitudes which can enhance clinical competency used in future practice. 13,14 Many healthcare disciplines have developed standards for IPE. For example, in nursing education, the Healthcare Simulation Standards of Best Practice: Simulation Enhanced IPE is used to guide IPE activities. 15 Additionally, the Commission on Accreditation of Athletic Training Education (CAATE) updated their standards for professional entry-level athletic training (AT) programs in 2020. 16 The new AT educational standards emphasize interprofessional collaboration while also reflecting the IPEC core competencies utilized in interprofessional simulation and standardized patient (SP) encounters. 16 2 | PROBLEM While medical student and nursing student IPE is well documented in the literature, other healthcare disciplines are often less addressed. 17 Our university has a college of health and human services which includes schools of Nursing, Social Work, and Health and Applied Human Sciences. This rich repository of healthcare students provides an opportunity to incorporate IPE into curricula and engage students across multiple academic programs.
This pilot Sim-IPE activity targeted two healthcare disciplines, AT and prelicensure nursing students. The literature on the collaboration of these two student groups is sparse but growing. 17 This article describes the development, implementation, and evaluation of a pilot Sim-IPE for AT and nursing students. The findings will inform future Sim-IPE activities involving additional groups of healthcare students.
The objective for the Sim-IPE activity was to provide a realistic healthcare scenario for students from different disciplines to learn about one another's profession, collaborate with one another, and communicate effectively as a team as they performed patient care.

| Evidence-based framework
The core competencies for interprofessional collaborative practices, created by the Interprofessional Education Collaborative (IPEC) 18 served as the foundation for the Sim-IPE. IPEC defines interprofessional collaboration through four core competencies: (a) values/ethics for interprofessional practice, (b) roles/responsibilities, (c) interprofessional communication, and (d) teams and teamwork. 18, 19 The pilot Sim-IPE incorporated the four core competencies in the simulation with the goal to prepare the healthcare students for interprofessional practice and collaboration.

| Study design
This mixed methods study employed a one-time posttest design for a convenience sample of AT and prelicensure nursing students following a simulation intervention. This nonexperimental Sim-IPE was reviewed and approved by the Institutional Review Board at the university.

| Participants
Twenty graduate-level AT students and 12 prelicensure nursing students from a university in the Southeastern United States participated. The AT students consisted of 11 first year-students (Cohort 1) and 9 second-year students (Cohort 2). Participation in the Sim-IPE was mandatory for the AT students as it was part of their semester clinical course requirement. Prelicensure nursing students ranged from the second semester through the fifth semester and participated voluntarily. Nursing students were recruited via email and were assigned to either Cohort 1 or 2 depending on their availability.

| Simulation design
The Sim-IPE was created by faculty from the Athletic Training Program and School of Nursing. The simulation was designed using the Health Care Standards of Best Practice. 8 Faculty from the two disciplines met biweekly over 3 months to outline the simulation and develop student objectives and outcomes. Two Sim-IPEs were designed to accommodate the knowledge level of the AT learners (1st-vs. 2nd-year students). The initial draft of the simulation was developed, then iteratively revised by the faculty.
The Sim-IPE consisted of three faculty-facilitated phases; a prebrief session, the simulation scenario, and a debrief session ( Figure 1).

| Prebrief session
Prebriefing, including preparation and briefing activities are considered standard of best practice and provide essential elements for achieving optimal student learning. 20 The AT and nursing students had limited or no prior Sim-IPE experience thus preparation materials were assigned before the activity. Prereadings included (1) 21 These materials allowed the students to be prepared for the Sim-IPE in effort to optimize successful learning outcomes. 20 The briefing conducted immediately before the Sim-IPE incorporated an orientation to the objectives, roles, and expectations for the students. 20 Students were oriented to aspects of the experience to help them achieve the objectives: scenario, equipment, SP, and the scenario environments.

| Simulation scenario (Cohort 1 and Cohort 2)
Ninety-minute Sim-IPE events were scheduled and implemented over two afternoons (one for Cohort 1 and the other for Cohort 2).
Each 90-min session was conducted three times to allow all students to participate and consisted of a prebrief, simulation scenario, and debrief. Each session consisted of two to three AT students and one to three nursing students. The 20-min simulation scenario consisted of an SP actor playing the role of a student-athlete "patient" who collapses in response to a hypoglycemic event. The scenario began at a simulated college cross-country event. The SP was warming up for the race using a stationary bicycle when the signs and symptoms of hypoglycemia emerged. For Cohort 1, the SP portrayed mild signs of hypoglycemia, confusion, irritability, and dizziness before collapsing.
For Cohort 2, who were further advanced in the program, the SP experienced severe signs of hypoglycemia including a seizure. The AT students performed the primary assessment on the patient, stabilized the patient, then transported the patient to the simulated medical tent staffed by the nursing students. The AT students gave a handoff report to the nursing students using the ISBAR communication tool.
The nursing students conducted a primary assessment and stabilized the athlete while awaiting paramedic transport to a hospital emergency department. The scenario ended with the nursing student giving a condition update using the ISBAR tool to communicate assessment findings to the healthcare provider played by a faculty member.

| Debrief session
AT and nursing faculty cofacilitated the debrief using the "Promoting Excellence And Reflective Learning in Simulation" (PEARLS) framework for debriefing. 22 PEARLS is an evidence-based effective framework that incorporates three educational strategies, (1) learner self-assessment, (2) facilitating focused discussion, and (3) providing directive feedback and/or teaching. 22,23 Students were guided through the process of summarizing the scenario events, reflecting on their performance, highlighting the interprofessional skills used, and assimilating knowledge gained from participating in the Sim-IPE. performance of the students during the simulation was not formally evaluated as this was a formative Sim-IPE experience.

| Data analysis
Univariate, descriptive procedures included counts (N) and proportions (%). SPICE-R response data were summarized by student cohort. All quantitative data were analyzed and visualized using SAS JMP Pro version 15 (SAS Institute).
Thematic analysis was used to examine responses to the openended questions. 27 The analysis team consisted of four coauthors who analyzed the qualitative data beginning with familiarizing themselves with the data and creating an audit trail. Initial codes were independently generated then reviewed and refined in team meetings. An initial coding guide was created by condensing similar codes. The analysis team then recoded the data using the guide and compared their second coding for consistency. After the final coding of the data, the analysis team identified a primary theme and subthemes characterizing the data into salient points.

| RESULTS
Thirteen students (N = 13) from Cohort 1 and 12 students (N = 12) from Cohort 2 completed the SPICE-R survey. Both cohorts were comprised mostly of women (~60%) and AT students (77% Cohort 1; 67% Cohort 2) ( Table 1). The other student discipline was comprised of nursing students. Most students strongly agreed/agreed for each of the SPICE-R survey questions (Table 2). One student responded "strongly disagree" to each survey question, however, there were no open-ended responses that gave additional insight into these responses.

| Importance of interprofessional communication
The students also described how the experience helped them think about the importance of interprofessional communication for patient safety, specifically during a patient handoff with one noting "Being able to understand the information nursing needs from AT for the patient to get the best care was beneficial." Another student commented on the structured communication tool, ISBAR, "I thought seeing an interdisciplinary team work together showed how important ISBAR is when conveying information." Another student commented, "I was with nursing students, and I got a view into their field and also how to interact with nurses."

| Importance of interprofessional collaboration
In addition to learning about one another's roles one student commented that the sim-IPE gave them the opportunity to teach others about their profession's roles, "'the Simulation' let us show them what we do as athletic trainers to advocate for our profession."

| Limitations
The authors acknowledge this pilot study had some limitations including the use of a posttest only design. In future work we will add F I G U R E 2 Thematic map a pretest so we can examine the students' perceptions before and after the intervention. A second limitation was the small sample size of students from a single university. Future work will include larger numbers of interprofessional students with appropriate study power considerations.

| CONCLUSION
Collaborative Sim-IPEs can be time-intensive to plan, schedule, and implement. They require expertise from differing course faculty to develop evidence-based scenarios and require a commitment to finding time that is suitable for all learners to meet. However, our pilot Sim-IPE successfully achieved the objectives to allow students from different healthcare professions to learn about one another's roles and responsibilities, collaborate as a team, communicate ideas, and listen to one another's perspectives. Introducing interprofessional collaboration to healthcare students is achievable and is key for continued successful work between professions. This is important for students from all healthcare professions to understand one another's scope of practice, roles, skills, and areas of expertise to improve outcomes for patients. A future simulation that will include healthcare students across multiple professions is currently being planned.